British journal of anaesthesia
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Clinical Trial
Remifentanil-midazolam sedation for paediatric patients receiving mechanical ventilation after cardiac surgery.
Sedation of critically ill children requiring artificial ventilation remains a therapeutic challenge due to large individual variation in drug effects and a paucity of knowledge of pharmacokinetics in this population. This study aimed to determine the pharmacokinetics of remifentanil in children requiring ventilation after cardiac surgery. ⋯ A combination of remifentanil and midazolam provided satisfactory sedation for these patients. Owing to enhanced clearance rates, smaller (younger) children will require higher remifentanil infusion rates than larger (older) children and adults to achieve equivalent blood concentrations.
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B-type natriuretic peptide (BNP) levels predict cardiovascular risk in several settings. We hypothesized that they would identify individuals at increased risk of early cardiac complications after major non-cardiac surgery. The current study tests this hypothesis. ⋯ In the setting of major non-cardiac surgery, preoperative BNP levels are higher in patients who experience perioperative death and myocardial injury. Larger studies are required to confirm these data and to clarify what BNP levels may add to existing methods of risk stratification.
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Randomized Controlled Trial
Comparison of intubating laryngeal mask airway and Bullard laryngoscope for oro-tracheal intubation in adult patients with simulated limitation of cervical movements.
Intubation of a patient with limited cervical spine movement or in whom movement of the cervical spine is not desirable is always a challenge even to the most experienced anaesthesiologist. The intubating laryngeal mask airway (ILMA) and the Bullard laryngoscope (BL) are two instruments recommended for endotracheal intubation of such patients. We compared their utility and safety in patients with simulated cervical spine immobility using manual inline stabilization (MILS). ⋯ Both the BL and the ILMA are useful equipment in intubating patients with limitation of cervical movements. Although not statistically significant, the BL may provide a higher success rate of intubation when compared with the ILMA.
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Case Reports
Prolonged myotonia and dystonia after general anaesthesia in a patient taking gabapentin.
This is the report of a 55-yr-old female who developed severe myotonia and dystonia after general anaesthesia. Before starting on gabapentin therapy for a neuropathic pain condition, she had undergone numerous uneventful general anaesthetics. ⋯ The events were unrelated to the choice of anaesthetic or anti-emetic. The most recent event that required a protracted stay in hospital after a day-case surgery is presented in detail, and the possible mechanisms to explain the interaction are discussed.
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Randomized Controlled Trial Multicenter Study Comparative Study
Single-dose aprepitant vs ondansetron for the prevention of postoperative nausea and vomiting: a randomized, double-blind phase III trial in patients undergoing open abdominal surgery.
The neurokinin(1) antagonist aprepitant is effective for prevention of chemotherapy-induced nausea and vomiting. We compared aprepitant with ondansetron for prevention of postoperative nausea and vomiting. ⋯ Aprepitant was non-inferior to ondansetron in achieving complete response for 24 h after surgery. Aprepitant was significantly more effective than ondansetron for preventing vomiting at 24 and 48 h after surgery, and in reducing nausea severity in the first 48 h after surgery. Aprepitant was generally well tolerated.